Medical Journal of Shree Birendra Hospital <p>Official Journal of NAIHS (Nepalese Army Institute of Health Sciences). Full text articles available.</p> <p>MJSBH is now accepting online submission of manuscripts.We recommend that you review the <a href="/index.php/MJSBH/about">About the Journal</a> page for the journal's section policies, as well as the <a href="/index.php/MJSBH/about/submissions#authorGuidelines">Author Guidelines</a>. Authors need to <a href="/index.php/MJSBH/user/register">register</a> with the journal prior to submitting, or if already registered can simply <a href="/index.php/index/login">log in</a> and begin the 5 step process.</p> NAIHS (Nepalese Army Institute of Health Sciences) en-US Medical Journal of Shree Birendra Hospital 2091-0185 <p>Copyright on any research article is transferred in full to the Medical Journal of Shree Birendra Hospital upon publication. The copyright transfer includes the right to reproduce and distribute the article in any form of reproduction (printing, electronic media or any other form).</p><p><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons Licence" /></a><br />Articles in the Medical Journal of Shree Birendra Hospital are Open Access articles published under a <a href="" rel="license">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a> (CC BY-NC-ND).</p><p>This license permits use, distribution and reproduction in any medium, provided the original work is properly cited, is not changed in any way, and is not used for commercial purposes.</p> It’s Time to Wake Up From Our Slumber <p>No abstract available.</p> Binod Karki ##submission.copyrightStatement## 2019-07-12 2019-07-12 18 2 1 1 10.3126/mjsbh.v18i2.24443 Clinico-pathological Profile of Late Onset Neonatal Sepsis in a Tertiary Centre of Nepal <p><strong>Background</strong><strong>:</strong> Neonatal sepsis is a major cause of neonatal morbidity and mortality. Late onset sepsis (LOS) is associated with community environment or postnatal exposure to hospital environment. Its incidence is rising due to greater survival of preterm neonates and very low birth weight babies. Because of difference in local epidemiology and possible variation with time, regular monitoring and updates on pathogen and their antimicrobial sensitivity pattern is important for prevention and treatment. The objective of this study was to identify the common symptoms and signs and determine the common bacterial isolates and&nbsp; antibiotic susceptibility pattern of&nbsp;late onset neonatal sepsis.</p> <p><strong>Methods: </strong>&nbsp;This was hospital based prospective observational study conducted among the neonates admitted with diagnosis of late onset neonatal sepsis in Kanti Children’s Hospital from July 2016 to June 2017.</p> <p><strong>Results:&nbsp; </strong>Poor feeding (89.6%), fever/hypothermia (47.2%), excessive/ poor cry (40.8%) and irritability/lethargy (33.6) were the common symptoms. Staphylococcus aureus and Coagulase negative staphylococcus (CONS), the most predominant organisms, were isolated in 66.7%&nbsp;&nbsp; and 18.5% of culture positive cases respectively. Most of the isolated organisms showed sensitivity to cloxacillin (16/27), amikacin (15/27), ciprofloxacin (14/27), cefotaxime (11/27), cotrimaxazole (6/27) and&nbsp; amoxyclox (6/27).</p> <p><strong>Conclusion:</strong>&nbsp; Poor feeding, fever/hypothermia, excessive/ poor cry and irritability/lethargy were the common symptoms. This study has indicated possible emergence of Staphylococcus aureus as the dominant cause of late onset&nbsp;neonatal sepsis. Cloxacillin, amikacin, ciprofloxacin and cefotaxime were more efficacious against the commonly isolated bacteria in late onset neonatal sepsis.</p> Deepak Mishra Ram Hari Chapagain Susan Bhattarai Nitu Kumari Jha Rakesh Mishra ##submission.copyrightStatement## 2019-07-12 2019-07-12 18 2 2 6 10.3126/mjsbh.v18i2.23517 Comparative Study of Propofol and Etomidate on the Haemodynamic Effects During Induction and Endotracheal Intubation <p><strong>Introduction: </strong>While most intravenous induction agents decrease arterial blood pressure, laryngoscopy and endotracheal intubation increase the heart rate and blood pressure. Propofol causes a decrease in systemic blood pressure whereas etomidate has minimal effects on the cardiovascular system. This study aims to evaluate and compare the hemodynamic effects of propofol and etomidate during induction and endotracheal intubation.</p> <p><strong>Methods: </strong>62 ASA I and II patients, 20-60 years of age, scheduled for elective surgery were enrolled in this prospective, randomised and double blind comparative study. Group A received inj. Propofol (2 mg/kg) and group B received inj. Etomidate (0.3 mg/kg), as induction agents. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were recorded after induction and after intubation at one, three, five and ten minutes and intergroup comparisons were made.</p> <p><strong>Results: </strong>After induction the decrease in systolic, diastolic and the mean arterial pressures were more in group A compared to group B (p = 0.003, 0.004 and 0.002). After 1 minute of intubation all haemodynamic parameters increased from the baseline with no significant differences between the two groups (p &gt;0.05). At three minutes the decrease in heart rate, diastolic blood pressure and mean arterial pressure was more in group A than group B with p values of 0.001, 0.002 and 0.05, however systolic blood pressures showed no significant difference (p = 0.144). The decrease in blood pressures showed significant difference between the two groups (p &lt;0.05) at five and ten minutes but the decrease in heart rate remained significant only at five minutes of intubation (p = 0.001).</p> <p><strong>Conclusions: </strong>Propofol and etomidate are both effective in preventing the haemodynamic changes due to induction and endotracheal intubation, with etomidate providing more haemodynamic stability.</p> Mallika Rayamajhi Puja Thapa Anjan Khadka Biswa Ram Amatya Udaya Bajracharya ##submission.copyrightStatement## 2019-07-12 2019-07-12 18 2 7 15 10.3126/mjsbh.v18i2.20907 Comparison of Maximum Phonation Duration and S/Z Ratio in Individuals with Asthma, Tuberculosis and Clinically Normal Voice <p><strong>Introduction: </strong>The ability of a person to phonate a sound gets affected in different laryngeal and respiratory pathology which can be measured by the help of two measure called as Maximum Phonation Duration (MPD) and S/Z ratio that&nbsp; helps to assess the efficiency of&nbsp; respiratory and phonatory system. The aim of this study is to measure the MPD and S/Z ratio in Normal, Tuberculosis and Asthma group patient.</p> <p><strong>Methods:</strong> The participant included Normal, Asthma and Tuberculosis patient where the recording was made in a quiet room with the help of PRAAT software and the participant were asked to sustain phonation of sound on single breath. Analysis was done with helps of SPSS version 25.0.</p> <p><strong>Results: </strong>There was a significant difference noted in MPD of /a/, /i/, /u/ sound between control and experimental group. MPD were significantly shorter in Asthma and Tuberculosis group compared to Normal group with no significant difference in S/Z ratio.</p> <p><strong>Conclusions:</strong> Maximum Phonation Duration is more reduced in Asthma and Tuberculosis patient compared to Normal group which indicate Asthma and Tuberculosis patient has to put more effort to phonate a sound.</p> Susmita Shrestha Anil Kumar Adhikari ##submission.copyrightStatement## 2019-07-12 2019-07-12 18 2 16 21 10.3126/mjsbh.v18i2.24089 Determinants and Aspirants of Nurse Migration from Nepal: A Cross Sectional Study from Kathmandu <p><strong>Introduction: </strong>Migration is the result of interplay of many factors, which guide the individual’s decision to emigrate. Health workers tend to go where the working conditions are best. This study aims to identify the determinants and aspirants of nurse migration from Nepal.</p> <p><strong>Methods: </strong>A descriptive cross sectional study was conducted using interview technique. A semi structured questionnaire was administered to all nurses working at a private hospital who met the inclusion criteria.</p> <p><strong>Results: </strong>Majority of the participants were 20- 30 years old (93.20%), Hindu (86.5%), Chhetri (35.1%), unmarried (66.2%), had completed intermediate level (58.1%). Among the total respondents, 93.20% intended to migrate to abroad and more than half of the respondent (62.20%) preferred Australia as destination. The general factor provoking migration was bad nature of politician (98.6%) followed by political instability (90.5%) and non-availability of job (90.5%). The major working condition and social factors provoking migration were occupational security in other country (85.10%) and peer influence (91.9%) respectively. The reasons for migration as mentioned by respondents were education (59.50%) followed by better job opportunities (40.50%), better living standard (21.60%) and family and/or peer pressure (8.10%).</p> <p><strong>Conclusions: </strong>The present study concluded that majority wanted to migrate and Australia was famous choices for nurses. Bad nature of politician, occupational security in other country and peer influence were factors for migration.&nbsp; The major purpose for migration was education.</p> Sabika Munikar Kanchan Thapa ##submission.copyrightStatement## 2019-07-12 2019-07-12 18 2 22 28 10.3126/mjsbh.v18i2.22855 Incidence and Risk Factors of Low Birth Weight Among Babies Delivered at Tertiary Level Teaching Hospital in Nepal <p><strong>Introduction: </strong>Low birth weight is directly related to both immediate and long term development and wellbeing of a person. There are numerous maternal and foetal factors contributing to low birth weight. The mortality and morbidity of low birth weight can be reduced if the maternal risk factors are detected early and managed by simple techniques.</p> <p><strong>Methods: </strong>207 low birth weight live newborn babies regardless of gestational age born in a tertiary level teaching institute from September 2015 to September 2016 were enrolled as cases and same number of normal birth weight babies (i.e. 2.5 to 4 kgs) as control. Information was obtained directly from mothers using pretested structured questionnaire and was analysed using SPSS version 20.</p> <p><strong>Results: </strong>The incidence of low birth weight was found to be 9.8%. Mean weight of low birth weight babies was 1.98 kg and mean gestational age was 37.34 weeks. Among low birth weight babies, 47.8% were preterm and 52.2% were term. Out of 119 small for gestational age babies, the frequency of symmetrical small for gestational age was 45.3% and asymmetrical small for gestational age was 54.6%. There was significant association of low birth weight with multiple maternal factors like maternal age, education, weight, height, weight gain during pregnancy, ANC visits, parity, antepartum haemorrhage, previous abortion/low birth weight, birth spacing, tobacco/alcohol intake and haemoglobin.</p> <p><strong>Conclusions: </strong>Prevalence of low birth weight is likely to be far higher than figure in isolated rural settings of our country. Contribution of SGA is higher than Appropriate for Gestational Age which brings us to a larger burden of long term morbidity and mortality. Various maternal factors are responsible for birth of low birth weight babies. &nbsp;</p> Pawana Kayastha Sunil Raja Manandhar ##submission.copyrightStatement## 2019-07-12 2019-07-12 18 2 29 35 10.3126/mjsbh.v18i2.22202 Prevalence of Metabolic Syndrome in Patients With Type 2 Diabetes Mellitus in a Tertiary Care Hospital <p><strong>Introduction: </strong>Diabetes mellitus is associated with various metabolic disorders, which leads to the progression of the disease and its complications. The aim of the study is to find out prevalence of metabolic syndrome and its association with the components and demographic variables.</p> <p><strong>Methods: </strong>This cross-sectional study was conducted among diabetes mellitus patients at a Tertiary level teaching hospital over a period of one year (April 2015 to March 2016). The study involved the use of a questionnaire to obtain information on diabetes by performing anthropometric measurements and corroborating it with respective blood samples collected for the measurement of biochemical parameters, fasting blood glucose and lipid profile. Metabolic syndrome was defined according to the current guidelines, revised in 2005 by the National Heart, Lung and Blood Institute and the American Heart Association. Statistical Package for the Social Sciences Version 20 was used as a tool for statistical analysis.</p> <p><strong>Results: </strong>This cross-sectional study involved 200 type 2 diabetes mellitus patients. The prevalence of metabolic syndrome was 71% in the studied Nepalese population. Central obesity (77.5%) and hypertension (76.8%) were the commonest risk factors. It was followed by dyslipidemia among which 65.5% had high triglyceride level and 50.7% had low level of high density lipoprotein cholesterol. Higher prevalence of metabolic syndrome was seen in male patients with type 2 diabetes which accounted for 84 (73.3%). Three components of metabolic syndrome were seen among 70 (35%) and five components among 29 (14.5%) patients. Among the patients who were studied, the age group 45 to 54, 55 to 64 and 65 to 74 years had 14 (20%), 20 (28.6%) and 19 (27.1%) of more than three components of metabolic syndrome respectively.</p> <p><strong>Conclusions: </strong>The prevalence of metabolic syndrome was 71% among the patients with type 2 diabetes, where high prevalence was seen among males. In our study central obesity and hypertension along with increasing age were the most common component causing metabolic syndrome. &nbsp;</p> Dipesh Shakya Vijay KC ##submission.copyrightStatement## 2019-07-12 2019-07-12 18 2 36 41 10.3126/mjsbh.v18i2.22207 The Safety and Efficacy of Mini Percutaneous Nephrolithotomy During Learning Curve <p><strong>Introduction: </strong>Since its introduction in 1976, percutaneous renal stone surgery has undergone several modifications. Reduction in size of access sheath was one of them which was first reported by Jackman in 1998. The miniaturisation of access sheath in Mini-Percutaneous Nephrolithotomy surgery has significantly reduced the intervention related morbidity with similar outcome as of standard Percutaneous Nephrolithotomy.</p> <p><strong>Methods: </strong>This is a prospective cohort study where a single surgeon without previous experience of independent PCNL surgery performed Mini PCNL under controlled condition for renal stone sized 10 to 30 mm. The outcome was measured in terms of stone free rate and postoperative complications. The association of stone free rate and drop in haemoglobin level with different preoperative and operative variables were calculated with Pearson’s correlation test and p value &lt;0.05 was considered significant.</p> <p><strong>Results: </strong>Mini PCNL was performed in total of 63 renal units. The mean age was 37.8 ± 9.9 years with male: female ratio of 1.8:1. The average stone size was 16.8 ± 2.9 mm. The mean operative time was 55.2 ± 19.0 (30-110) minutes. The stone free rate was 98.2 ± 3.6 %. The mean drop in haemoglobin was 1.3 ± 0.8 and blood transfusion rate was 4.7%. The average hospital stay was 2.6 ± 1.3 days. The grade I complications was 15.8% and grade II and III was 7.9% each. Stone free rate was significantly associated with stone number (r = -0.47, p = 0.004). Similarly fall in haemoglobin was associated with total operative time (r = 0.49, p = 0.003). The stone size, hardness of stone (HU) and size of access sheath had no significant association with stone free rate and fall in haemoglobin.</p> <p><strong>Conclusions: </strong>Mini PCNL is as effective as standard PCNL with higher safety margin in small and medium size stone (10 to 30 mm) during learning curve of endo-urology procedure. &nbsp;</p> Bikash Bikram Thapa Bina Basnet Bikash Bahadur Rayamajhi Narayan Thapa Bharat Bhadur Bhandari ##submission.copyrightStatement## 2019-07-12 2019-07-12 18 2 42 47 10.3126/mjsbh.v18i2.21355 The Study on Dorsal Venous Arch of Upper Limb Among Nepalese Medical Students at Tertiary Level Teaching Institute <p><strong>Introduction: </strong>Dorsal venous arch of upper limb is the beginning site for cephalic and basilic veins. The superficial veins are clinically important for venipuncture, blood collection and blood donation as well as for health screening and testing, intravenous transfusion for the emergency treatment of hypovolemic shock. Veins of the upper limb are also used for total parental nutrition, therapeutic invasive procedure and blood samples. The Dorsal Venous Arch is superficially placed and can be easily made prominent by putting a tourniquet at the wrist for any such surgical and therapeutic purposes.</p> <p><strong>Methods: </strong>It was a cross-sectional observational study conducted in 200 hands among 100 individuals from MBBS first and second year students studying at a Medical College. Body Mass Index (BMI) of individuals was calculated to observe the correlation between length of the dorsal venous arch and BMI.</p> <p><strong>Results: </strong>The mean±s.d. length of dorsal venous arch in male on right hand (20.7±2.4 cm) was significantly greater than in female on right hand (19.4±2.1 cm).There was no significant difference in length of dorsal venous arch on left side between male (20.1±2.2 cm.) and female (19.3±1.8 cm).</p> <p><strong>Conclusions: </strong>The length of the dorsal venous arch on right hand was found significantly greater in male than in female. Also the length of dorsal venous arch on right side was found to be more than on left side in both sexes. The male students are significantly older, heavier and taller than females. &nbsp;</p> Nripendra Tiwari Deepesh Budhathoki Krishna Banshi Malla ##submission.copyrightStatement## 2019-07-12 2019-07-12 18 2 48 52 10.3126/mjsbh.v18i2.21216 Use of Granulocyte Colony-Stimulating Factor Among Patients of Chronic Liver Disease in a Tertiary Hospital in Nepal: A Pilot Study <p><strong>Introduction: </strong>Granulocyte colony stimulating factor improves short-term survival and clinical outcomes in alcoholic hepatitis, acute-on-chronic liver failure and decompensated chronic liver disease. Our study aimed to assess survival benefit and change in Child-Turcotte-Pugh and Model For End-Stage Liver Disease scores 30 days after Granulocyte colony stimulating factor therapy in chronic liver disease patients, irrespective of their mode of presentation.</p> <p><strong>Methods: </strong>This was a prospective observational study conducted in a university teaching hospital, where 25 patients with chronic liver disease were given 300 micrograms of Granulocyte colony stimulating factor subcutaneously 12 hourly plus standard medical therapy. We assessed survival until day 30. Child-Turcotte- Pugh and Model For End-Stage Liver Disease scores at enrolment and 30 days after treatment were compared.</p> <p><strong>Results: </strong>21 of 25 patients treated with Granulocyte colony stimulating factor survived at day 30. Treatment with Granulocyte colony stimulating factor reduced Child-Turcotte-Pugh score from 10.33 ± 1.24 to 8.76 ± 1.79 (p&lt; 0.001) at day 30 and Model For End-Stage Liver Disease score from 22.10 ± 4.67 to 16.38 ± 5.52 (p &lt; 0.001) at day 30.</p> <p><strong>Conclusions: </strong>Granulocyte colony stimulating factor improves clinical outcome, Child-Turcotte-Pugh and Model For End-Stage Liver Disease scores in patients admitted with chronic liver disease for any cause. Further studies are needed to explore whether lower doses (total six doses) of Granulocyte colony stimulating factor are as effective as higher doses (total 10 doses).&nbsp;</p> Rahul Pathak Sabin Thapaliya ##submission.copyrightStatement## 2019-07-12 2019-07-12 18 2 53 59 10.3126/mjsbh.v18i2.23038 A Case of Peritoneal-Pelvic Tuberculosis With Elevated CA-125; An Enigma as Ovarian Cancer <p>Peritoneal-pelvic tuberculosis is a rare form of extrapulmonary-TB mainly affecting women of 20-40 years, especially in TB endemic countries. It classically presents with abdominal pain, menstrual irregularities, adnexal mass, and elevated serum CA-125 level, creating confusion with genital malignancy, especially ovarian one leading to difficulty in its management and often leads to devastating surgeries. Here's a case of peritoneal-pelvic TB, a young lady with abdominal pain, radiologic associates and adnexal mass, and elevated serum CA-125 level is presented. So, it should always be one of the differential diagnosis of ovarian cancer especially among young women in TB endemic countries.</p> Prakash Raj Oli Rosy Vaidya Malla Kavita Karmacharya ##submission.copyrightStatement## 2019-07-12 2019-07-12 18 2 60 63 10.3126/mjsbh.v18i2.22390 A Fatal Case of Cerebral Melioidosis <p>&nbsp;</p> <p><strong>Introduction: </strong>Melioidosis is potentially fatal type of infectious disease caused by soil saprophytes <em>Burkholderia pseudomallei. </em>It is endemic to Southeast Asia and Northern Australia. We report the case of Cerebral Melioidosis which was consequences of acute otitis media. Patient was treated with Ceftazidime and Meropenem, despite of that patient died. To the best of our knowledge, this is the first case of cerebral melioidosis from Nepal. &nbsp;</p> <p><em>&nbsp;</em></p> Raina Chaudhary Alina Singh Manoj Pradhan Reeba Karki Paawan Bahadur Bhandari ##submission.copyrightStatement## 2019-07-12 2019-07-12 18 2 64 68 10.3126/mjsbh.v18i2.22705 Recent Advances in Neurosurgery <p>Neurosurgery, a new subspecialty, is constantly evolving and changing over a period of time. In recent times, new insights and requirements in terms of knowledge and practice, sub-specialisation among consultants and use of multidisciplinary teams of neurosurgeons, radiologists, anaesthesiologists, and pathologists are involved to tackle neurological problems. In recent years, newer advanced technologies have expanded and redefined the discipline of neurosurgery</p> Subodh Sharma Paudel Ritesh Luitel ##submission.copyrightStatement## 2019-07-12 2019-07-12 18 2 69 72 10.3126/mjsbh.v18i2.24352